Perspectives of beneficiaries, health service providers, and community members on a maternal and child health conditional cash transfer pilot programme in Nigeria

Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study

Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through conditional cash transfer (CCT) influenced the uptake of MCH services in the programme. Methods: The study used a descriptive exploratory approach in Anambra state, southeast Nigeria. Data was collected through qualitative [in-depth interviews (IDIs), focus group discussions (FGDs)] and quantitative (service utilization data pre- and post-programme) methods. Twenty-six IDIs were conducted with respondents who were purposively selected to include frontline health workers (n = 13), National and State policymakers and programme managers (n = 13). A total of sixteen FGDs were conducted with service users and their family members, village health workers, and ward development committee members from four rural communities. We drew majorly upon Skinner's reinforcement theory which focuses on human behavior in our interpretation of the influence of CCT in the uptake of MCH services. Manual content analysis was used in data analysis to pull together core themes running through the entire data set. Results: The CCTs contributed to increasing facility attendance and utilization of MCH services by reducing the financial barrier to accessing healthcare among pregnant women. However, there were unintended consequences of CCT which included a reduction in birth spacing intervals, and a reduction of trust in the health system when the CCT was suddenly withdrawn by the government. Conclusion: CCT improved the utilization of MCH, but the sudden withdrawal of the CCT led to the opposite effect because people were discouraged due to lack of trust in government to keep using the MCH services. Understanding the intended and unintended outcomes of CCT will help to build sustainable structures in policy designs to mitigate sudden programme withdrawal and its subsequent effects on target beneficiaries and the health system at large.

Undernutrition and malaria among under-five children: findings from the 2018 Nigeria demographic and health survey

Malaria and undernutrition have independently contributed to mortality and morbidity among the under-five population of Nigeria. However, there remains complexity in their association. This study evaluates the association between stunting, underweight, wasting, and malaria among under-five Nigerian children while assessing the effects of sociodemographic factors. Cross-sectional data from the 2018 Nigeria Demographic and Health Survey were used, which included a study population of 12,996 children aged 0-59 months. Stunting (HAZ<-2.0 SD), underweight (WAZ<-2.0 SD), wasting (WHZ<-2.0 SD), malaria test results, and sociodemographic factors were obtained and examined. Logistic regression modeling was used to determine the associations between undernutrition, malaria, and sociodemographic factors. The prevalence of stunting was 37.0%, with 22.0% underweight, 6.9% wasting, and 22.6% tested positive for malaria. Stunting was frequent among 24-35 months old, 12-23 months old were mostly underweight and wasted, and 48-59 months old frequently suffered from malaria. Undernutrition and malaria frequently occurred among males, residents of rural areas, the poorest wealth quintile, and children of mothers with no formal education. The odds of having malaria was 89% higher among under-five stunted children (AOR = 1.89, 95% CI = 1.00,1.40; p-value = <0.0001). However, underweight (AOR = 1.11, 95% CI = 0.91,1.36; p-value = 0.2982) and wasting (AOR = 0.89, 95% CI = 0.67,1.19; p-value = 0.4519) were not significantly associated with malaria. The development of appropriate strategies, especially in rural areas and for less-educated mothers are critical to combat undernutrition and malaria.